评估 MRI 左心室整体功能指数（LVGFI）在维持性透析终末期肾病患者中的预后价值。

Assessment of the Prognostic Value of MRI Left Ventricular Global Function Index (LVGFI) in Patients With End-Stage Renal Disease Under Maintenance Dialysis.

机构信息

Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

出版信息

J Magn Reson Imaging. 2024 Jun;59(6):2275-2286. doi: 10.1002/jmri.28979. Epub 2023 Sep 5.

DOI:10.1002/jmri.28979

PMID:37668069

Abstract

BACKGROUND

Left ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end-stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear.

PURPOSE

To investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD.

STUDY TYPE

Prospective.

POPULATION

One hundred fifty-eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis.

FILED STRENGTH/SEQUENCE: 3.0 T, balanced steady-state free precession (bSSFP) cine and modified Look-Locker inversion recovery (MOLLI) sequences.

ASSESSMENT

LV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median.

STATISTICAL TESTS

Cox proportional hazard regression and log-rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C-statistics and DeLong tests. A P value <0.05 was considered statistically significant.

RESULTS

Thirty-four MACE occurred during the median follow-up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C-statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%).

DATA CONCLUSION

LVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 3.

摘要

背景

左心室整体功能指数（LVGFI）综合了左心室容积和功能参数。在终末期肾病（ESRD）患者中，心脏损伤表现为左心室肥厚和功能障碍。然而，LVGFI 在该人群中的预后价值尚不清楚。

目的

探讨 LVGFI 与 ESRD 患者主要不良心脏事件（MACE）的相关性。

研究类型

前瞻性。

人群

158 名接受维持性透析的 ESRD 患者（平均年龄：54.1±14.4 岁；105 名男性）。

检查方法

3.0T，平衡稳态自由进动（bSSFP）电影和改良 Look-Locker 反转恢复（MOLLI）序列。

评估

从 bSSFP 图像中确定左心室容积和功能参数。LVGFI 计算为每搏量与整体容积的比值，从 MOLLI T1 图中确定原生 T1。在随访中记录 MACE。分别建立模型，从常规风险因素结合 LVGFI、GLS、原生 T1 和左心室质量指数（LVMI）预测 MACE。进一步在左心室射血分数（LVEF）高于中位数的参与者中进行亚组分析。

统计学检验

Cox 比例风险回归和对数秩检验用于研究 LVGFI 与 MACE 之间的关系。使用 Harrell 的 C 统计量和 DeLong 检验评估和比较预测模型。P 值<0.05 被认为具有统计学意义。

结果

在中位数 26 个月的随访期间，发生了 34 例 MACE。在单变量分析中，LVGFI 每降低 10%，MACE 的风险增加 114%。由 LVGFI 组成的预测模型（C 统计量：0.724）的预测性能明显优于其他模型（均 P<0.001）。这些结果在 LVEF>中位数（63.54%）的患者（N=79）中是一致的。